Statement of Max Richtman President and CEO

National Committee to Preserve Social Security and Medicare 

Committee on Finance, United States Senate

Hearing to Consider the Graham-Cassidy-Heller-Johnson Proposal

Monday, September 25, 2017, 2:00 P.M.

Washington, DC


Chairman Hatch and Ranking Member Wyden:

I am Max Richtman, President and Chief Executive Officer of the National Committee to Preserve Social Security and Medicare, and I appreciate the opportunity to submit this statement for the record.  With millions of members and supporters across America, the National Committee is a grassroots advocacy and education organization dedicated to preserving and strengthening safety net programs, including Medicaid and the Affordable Care Act (ACA), which provide health insurance to millions of older and disabled Americans – Americans who would be greatly harmed by passage of the Graham-Cassidy amendment to the House-passed American Health Care Act.

Like the House-passed ACA repeal legislation, the Graham-Cassidy bill would leave millions of Americans uninsured and would be particularly harmful to older and disabled Americans.

Americans have a right to know how this bill would impact them.  Regretfully, the Majority Leadership is rushing the Senate to blindly consider Graham-Cassidy without fully vetting this proposal in committee hearings and mark-up, where amendments could be considered, and without a full Congressional Budget Office (CBO) score.  CBO previously estimated that repeal-without-replace would cause 32 million people to lose health coverage.  Senate consideration of any bill that would change the accessibility and affordability of essential health care for millions of Americans without a complete CBO analysis and committee debate would be the height of legislative malpractice.

This bill is particularly objectionable because it would:

  • Jeopardize long-term care and other supportive services by restructuring Medicaid into per capita caps or block grants.  Middle-class Americans often rely on Medicaid for long-term services and supports when they exhaust their savings.  Nearly two-thirds of all nursing home residents’ care is financed in part by Medicaid.  In addition, Medicaid provides home and community-based services that allow seniors to stay in their homes.  According to an analysis by the health consulting firm Avalere, reductions to the traditional Medicaid program by Graham-Cassidy compared to current law would exceed $1 trillion by 2036.
  • End Medicaid expansion, which would take away health coverage from 11 million Americans, including low-income older adults under the age of 65. Through 2036, Avalere projects the reduction in federal funding to expansion states relative to current law would be $3 trillion.
  • Drive up out-of-pocket costs for the six million seniors, 50- to 64-year olds, who purchase insurance in the individual market by repealing the ACA’s premium tax credits and cost-sharing reductions.
  • States could allow insurance carriers to:
    • Charge older adults age 50 to 64 higher premiums based on their age by waiving federal protections that limit age rating.
    • Charge certain enrollees with pre-existing conditions thousands of dollars more than healthier individuals. This proposal would be particularly harmful to the 40 percent of enrollees age 50 to 64 who have one or more pre-existing condition.
    • Pick and choose which essential health benefits – such as prescription drugs, chronic disease management and maternity care – their plans will cover.  Without the essential benefits requirement, health plans may not cover chemotherapy for cancer patients or insulin for diabetics.  In a health insurance market without risk sharing, comprehensive coverage would be unaffordable because most plan enrollees would have pre-existing conditions.

CBO has previously estimated that this flexibility for insurance carriers will substantially increase costs for older and sicker individuals.

The National Committee believes this legislation is so deeply flawed that Congress should instead recommit to the Senate Committee on Health, Education, Labor and Pensions Chairman Lamar Alexander and Ranking Member Patty Murray’s bipartisan effort to strengthen the ACA’s individual health insurance market reforms.  In that spirit, we believe Congress should prioritize lowering costs for all Americans regardless of health status and age and protecting existing programs like Medicaid, Medicare and the Affordable Care Act.

But first, we urge Senators to vote against the Graham-Cassidy bill which would put seniors and people with disabilities at significant risk of ending up uninsured and losing access to needed care.

Thank you again for the opportunity to share the National Committee’s opposition to the Graham-Cassidy proposal.